Provider Demographics
NPI:1407477862
Name:MELLO, MELODY (RBT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MELLO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 PARKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3265
Mailing Address - Country:US
Mailing Address - Phone:903-312-1315
Mailing Address - Fax:866-790-8027
Practice Address - Street 1:903 PARKVIEW CIR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3265
Practice Address - Country:US
Practice Address - Phone:903-312-1315
Practice Address - Fax:866-790-8027
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-18-74653OtherBACB